Please read the following carefully, and check "I agree" when you are ready to proceed.
Waiver and Release of Liability
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
5. If you have diabetes (type I or II) have you had trouble controlling your blood glucose in the last 3 months?
6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
7. Do you have any other medical condition/s that may make it dangerous for you to participate in physical activity/exercise?
IF YOU ANSWERED ?YES? to any of the 7 questions, please seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/exercise.
IF YOU ANSWERED ?NO? to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.
Authorisation - I hereby agree that by checking the 'I AGREE WITH THE ABOVE TERMS' box I have answered no to all 7 of the above questions, or otherwise have consulted my GP or appropriate allied health professional who has cleared me to undertake this exercise program.
High intensity exercise must be approached cautiously in the beginning, a gradual ramp up of intensity is necessary to allow muscle cells to adapt to the new demands being placed on them. Failure to do so, opens the door to a life threatening condition, know as ?Rhabdomyolysis?. In short, the muscle cells are damaged flooding the bloodstream with toxins that can overwhelm the kidneys as they attempt to cleanse the blood, leading to potential shutdown. CrossFit can cause Rhabdomyolysis. It is important that you start at a reduced intensity. Brown urine, complete muscle weakness and/or swelling of joints are warning signs of ?Rhabdo?. If you develop these symptoms, seek medical assistance IMMEDIATELY.
In consideration of CrossFit Dromana allowing me to participate, I acknowledge, understand and I am aware that:
I have voluntarily chosen to participate in training activities provided by CrossFit Dromana. I understand there are inherent risks in all aspects of physical training and I acknowledge that I have been informed of the possible strenuous nature of the training and the potential for undesirable physiological results including, but not limited to, abnormal blood pressure, muscle soreness, fainting, heart attack and/or death. I also acknowledge that I have been specifically warned about the medical condition ?Rhabdomyolysis? and accordingly I have been advised to limit my effort in order to minimise the risks associated with this condition.
I understand that the training may involve weightlifting, gymnastic movements, strenuous bodyweight exercises and other high exertion activities, and that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my trainer. I give CrossFit Dromana and the staff of the facilities I train in permission to seek emergency medical services for me should I become injured or ill with the understanding that I am responsible for any expenses incurred.
I agree to WAIVE ANY AND ALL CLAIMS that I have or may have in the future against CrossFit Dromana, and its directors, officers, employees, agents, volunteers and independent contractors (all of whom are hereinafter collectively referred to as ?the Releasees?). I agree to RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in the programs, activities and services provided by CrossFit Dromana, due to any cause whatsoever including negligence, breach of contract, or breach of any statutory or other duty of care. I agree to HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my participation in any program, activity or service provided by the releasees.
This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with CrossFit Dromana to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.
Use of picture(s)/film/likeness: I agree to allow CrossFit Dromana, its agents, officers, principals, employees and volunteers to use picture(s), film and/or likeness of me for advertising purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform CrossFit Dromana of this in writing.
I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY CHECKING THE 'I AGREE ON THE ABOVE TERMS' BOX ON THIS ?INFORMED CONSENT FORM? I AM WAIVING CERTAIN LEGAL RIGHTS (INCLUDING THE RIGHT TO SUE) WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTOR, ADMINISTERS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES. ANY QUESTIONS I HAD WERE ANSWERED TO MY FULL SATISFACTION.